Waste not,want notInformation and its role in reducing medication waste
“Waste not, want not” is a phrase first recorded in
the late 18th Century and means if one is not
wasteful then one will not be needy – applying this
to healthcare is complex.
There are many areas of waste in any system but
due to the size of healthcare, the number of
employees and its significant cost as a proportion
of a nation’s GDP, any inefficiencies can have an
enormous impact.
In healthcare, these can lead to different types of
waste, including time, resources and medications.
The purpose of this paper is to look mainly at the
issue of medications waste, an area where the use
of better information could significantly reduce the
problem.
There is a lot of research and discussion on how to
manage medication waste from an environmental
point of view because of the impact of incorrect
disposal and the effects of Active Pharmaceutical
Ingredients (APIs) as trace contaminants.
In New Zealand, medicine disposal has been
labelled a National Disaster, with official services
patchy and no studies on the long-term effects on
the environment (RNZ, 2015).
However, the discussion put forward below focuses
on how prescribed medication waste can be
reduced in the first place, so as to limit the need
for disposal. This is an upstream approach to the
issue rather than the downstream management of
the impacts of excess and unused medication.
It will argue that better information can lead to
more efficiency, but this will require a far wider
appreciation of its benefits and more use of
information technology.
It will look at the need for people to become more
engaged in their healthcare and to have greater
understanding about medication, its value and
efficacy.
It will cover changing perceptions about privacy
and potential changes to the medication supply
chain and delivery.
How does
medication waste
occur?
Non-adherence as
a primary problem
What is the cost of
medication waste?
The importance of
information
What more is
needed in the
future?
The discussion is covered in the following sections:
INTRODUCTION
1
2011
HOW DOES MEDICATIONWASTE OCCUR?We are all guilty – we all have medicine cabinets or
drawers at home with unused out of date
medication - it is a global problem.
So why does this occur?
For most of us, it’s probably a case that we just
didn’t finish the course of medication, or we forgot
to take it, didn’t remember we had it or kept it just
in case – the last of these is known as a
prophylactic approach (Ruhoy & Daughton, 2008).
Over-prescribing also happens, for instance when a
patient leaves hospital with a larger supply of pain
medication than is actually needed.
While for many it’s just a minor problem of a few
pills sitting in a drawer, there is a far larger issue of
medication waste and its disposal, on a national
and international scale.
There are many reasons for it, including
inefficiencies and certain practices of
manufacturers, distributors, prescribers,
dispensers and patients themselves (Ruhoy &
Daughton, 2008).
Specific ones include stat-prescribing or all at once
bulk dispensing. This was introduced in New
Zealand in 2003 and was predicted to increase
overall dispensed medications by 6 per cent
(Tong et al, 2011) or $48m based on a total
medication spend of $800m.
Stat prescribing is convenient for both the clinician
and patient, even if not all the medication is used.
One batch dispensing means less need for another
pharmacist visit, but the process is also indicative
of a low value perception of pharmaceuticals.
Figure 1.0: UK cost of unused medication and
what it could pay for?
The UK’s Department of Health estimates that
unused medicines cost the NHS around £300m
annually, (NZ$630m), with an estimated £110m
(NZ$230m) worth of medicine returned to
pharmacies, £90m (NZ$190m) worth of unused
prescriptions stored in homes and £50m (NZ$105m)
of medicines disposed of by Care Homes.
This would pay for:
• 11,778 community nurses, or
• 80,906 hip replacements, or
• 19,799 drug treatment courses for breast
cancer, or
• 300,000 drug treatment courses for
Alzheimer's, or
• 312,175 cataract operations
These startling figures don't even take into account
the cost to patients' health if medicines are not
being correctly taken.
Source: www.medicinewaste.com
2
This practice has also been normal for rest-homes
where bulk supplies have been provided to cover
needs with little reconciliation for used and unused
medication.
While rules for monthly supply came into effect a
few years ago for the aged care sector, there is still
waste resulting from medicine changes, such as to
packaging, and how these are managed.
the most prominent reason for waste is non-adherence
Probably the most prominent reason for waste is
non-adherence, identified by CapGemini (2012) as
one of the most serious problems in healthcare,
posing a heavy financial impact on all
constituencies.
Leftover unwanted pharmaceuticals tend to
accumulate after being set aside, stored or
forgotten – and this occurs at just about any
location where people live, work or visit. Locations
are associated with the demands and expectations
for the easy accessibility and availability of
medications (Ruhoy & Daughton, 2008).
we have become used to having medications available when and where we need them
Put simply we have become used to having
medications available when and where we need
them. Availability has become part of people’s
everyday lives. It’s a problem associated with the
ease of supply and people’s expectation that
medications will always be easily accessible.
What this hides is a lack of understanding about
these resources and how they could be directed
more efficiently to provide needed medical care
elsewhere.
3
NON-ADHERENCE AS A PRIMARYPROBLEMMedication non-adherence is a complex and major
public health issue with significant health and
economic consequences – it is well-known that
adherence and persistence (continuing to take
medications for the recommended duration)
affects treatment efficacy, costs, adverse event
rates and the severity of disease related sequelae,
overall health and quality of life (Kadambi, 2012).
The New England Healthcare Institute (2009)
estimated medications non-adherence is
responsible for US$290bn in “otherwise avoidable
medical spending” in the US alone each year from
waste and costly secondary healthcare.
non-adherence is a complex and major public health issue with significant health and economic consequences
In New Zealand, the conservatively estimated cost
of non-adherence is $700m or about 5 per cent of
total healthcare spend, mostly relating to
unplanned and avoidable hospitalisation due to
people not taking medication as prescribed.
Non-adherence is also associated with immense
personal and societal costs beyond the financial, in
the form of compromised quality of life, lost
productivity and untimely death. These
downstream effects are particularly tragic given
their preventability.
Medication non-adherence is very common with
rates of approximately 25-50 per cent reported in
major reviews with the problem set to grow as the
number of people living with long-term conditions
rises globally (Atlantis Healthcare, 2014). Some
studies even report rates up to 75 per cent.
Non-adherence occurs at various stages in the
medication supply chain from when the
prescription is provided but not filled by the
patient at a pharmacy, to being picked up but not
started, to not being finished (see figure 2.0)
non-adherence is also blamed for immense personal and societal costs beyond the financial
There are many reasons for non-adherence, some
of which include:
• Patient perceptions of their condition, the
need for medication and importance of
adherence – this relates to: the importance of
clear communication between clinicians and
patients to transcend difficulties with health
literacy; and the importance of how patients
view their disease and treatment, which may
not be the same as biomedical understandings
• Patient's coping style in relation to their
condition, with those experiencing denial less
likely to adhere
• Self-regulation – downward adjustment of
doses by the patient is a major factor in
“non-compliance”, and is caused by patients’
concerns regarding the medications
themselves (Pound et al, 2005). Patients will
imprudently discontinue medications for a
wide variety of reasons (Ruhoy & Daughton,
2008):
Some will think their condition is
resolved while others may think the
treatment is ineffective, accounting for
4
NotFilled
NotStarted
NotFinished
-12% -12% -29%
over half of the cost due to waste
(Morgan, 2005)
Side effects may also encourage a
patient to stop medication
Dosing schedules may be too complex
or inconvenient
• Cultural influences on medication taking may include non-adherence due to lack of trust in Western medicine, or cultural values where women prioritise the needs of their families over their need to take medication everyday
• Forgetfulness due to life demands and other priorities, probably common at times for everyone
Studies indicate non-adherence could be a lot higher than estimated because patients may be reluctant to disclose episodes of non-adherence to their doctor due to embarrassment or fear of criticism.
In other words, after receiving a prescription, there is a dual role where patient decision-making and access, and physician engagement, can affect each of the stages shown in figure 2.0. Each one is important and high non-adherence rates show a large gulf exists between the utility of a given medication as perceived by the physician and the realized welfare of the patient (Ellickson, Stern & Trajtenberg, 1999).
Surprisingly, research also shows the seriousness of the condition doesn’t necessarily encourage greater adherence with non-adherence pervasive in areas such as: immunosuppressant medication to prevent organ rejection after transplant, glaucoma medications to prevent vision loss or blindness, HIV medication to prolong life and adjuvant therapy to prevent cancer reoccurrence (CapGemini, 2012).
This is where medication adherence breaks down
American Heart Association 2009, Statistics You Should Know, www.americanheart.org
5
For an observer it would seem illogical not to take medication for a condition that if untreated will lead to a serious decline in health and potential death.
the seriousness of the condition doesn’t necessarily encourage greater adherence
However, this would ignore the all-important role of psychology in people’s non adherence to taking medication now for a health related pay-off in the distant future. In some cases, taking medication simply reminds people they are sick.
Even with interventions targeted at the psychology of medication taking it would be unrealistic to think medication adherence could be eliminated but it could be reduced. Even a 20 per cent improvement in New Zealand would mean a $140m saving on the total estimated cost of non-adherence of $700m, which would fund a lot of additional care.
taking medication simply reminds people they are sick
Addressing the causes of medication wastage, non-adherence being one, could improve therapeutic outcomes and reduce morbidity and mortality (Ruhoy & Daughton, 2008) as well as reducing the cost of healthcare.
Despite the importance of adherence and its profound effect on outcomes, historically it has been incorporated into economic modelling infrequently and has been considered in only a cursory manner in those instances where it is addressed (Kadambi et al, 2012).
More focus and investment on improving adherence would have the potential to have significant economic benefits.
Improvements in adherence are a win/win for all
stakeholders with regard to medicines, patients,
hospitalisations and medicine manufacturers.
Provided a patient is prescribed the correct
medicine at the right dose, actually taking it on
time every time should result in the patient
receiving the intended benefit.
Anna Stove, General Manager, GSK NZ Ltd
6
siificant
SO WHAT ISTHE COST OF MEDICATION WASTE?There are two principal costs: those related to
unused medication, or waste, and then the
significantly larger cost associated with providing
secondary care to non-adherent patients.
In New Zealand, there is an $800m annual spend
on pharmaceuticals, and an estimated $40m cost
from medication waste, or five per cent. Based on
figure 1.0, $40m would fund a significant number
of additional health services.
Research in other countries has found medication
waste, or the non-intention to take leftover
medicines prescribed within the past year
(Morgan, 2005), to be modest per individual but
significant when a total population is considered.
For instance, a US study found medication waste
cost US$30 for each retirement home resident over
65 years. This sounds modest but extrapolated out
nationwide and the total amount would be over
US$1bn (Morgan, 2005). While significant this is
minimal compared to the cost of avoidable
secondary care for non-adherent patients.
There is also a cost to the pharmaceutical industry
due to impacts on two revenue streams: people
not picking up their prescribed medication in the
first place and not continuing to take their
medication for the duration of the prescription.
Most critically, the latter impact also leads to
reputational risk for pharma companies as their
medicines are not being used in a manner to
optimise the best outcome for the patient.
If doctors and patients used prescription drugs
more wisely, they could save the US healthcare
system at least US$213bn a year by reducing
medication overuse, underuse and other flaws in
care that cause complications and longer more
expensive treatments (Johnson, 2013).
7
According to CapGemini estimated revenue lost by
the pharmaceutical industry in the US alone due to
non-adherence to medication for long-term
conditions is US$188bn (59% of the $320bn in
actual total revenue, or 37% of the $508bn in
potential total revenue). Extrapolated globally,
pharmaceutical revenue loss is estimated to be
$564bn annually, more than 18 times higher than
the $30bn most often quoted to date (CapGemini,
2012).
Pharmacy revenues are also affected if patients do
not pick up medication initially or over the course
of a long term condition.
Medication non-adherence also significantly
increases healthcare costs as a result of disease
related complications and improved adherence is a
clear win-win for all, most importantly for patients,
who benefit from better health and quality of life
(CapGemini, 2012).
improved adherence is a clear win-win for all
A US study provides a clear illustration of the
potential savings from the effective taking of
medication post-chronic heart failure. It found for
every dollar of medication taken there was an
US$8.40 saving downstream including reduced
hospital stays and visits (Atlantis Healthcare, 2014).
Another report, “Avoidable Costs in Healthcare”, by
IMS Institute for Healthcare Informatics found the
biggest area of waste (in the US) is patients not
taking medicines prescribed by their doctor, either
at all or as directed (Johnson, 2013). It showed
more appropriate use of medication, taking it
exactly as prescribed, not taking antibiotics for viral
illnesses, preventing medication errors and the like,
could prevent 6m hospitalisations, 4m trips to the
emergency room and 78m visits to doctors and
other outpatient care providers each year.
As a significant cost and saving opportunity in any
healthcare system, medication and its
management needs more research and this is
where information plays such an important role.
medication and its management needs more research
Clearly, understanding the link between supply and
consumption, as well as having robust and accurate
feedback, would allow prescribers to make better
informed prescribing and volume decisions.
8
modern
THE IMPORTANCE OF INFORMATIONAs the father of modern management thinking
Peter Drucker’s famous saying “if you can’t
measure it you can’t manage it”, is now part of
management folklore and highly applicable to the
management of medication and therefore waste.
If medication usage isn’t measured, there is no
information to work with.
In the past, once a medication was prescribed and
dispensed, the trail of information ended and with
it any ability for it to be managed.
But now with systems collecting non-identifiable
data, such as ePrescribing, there is potential to
manage medications better, to reduce waste.
Information drives the medication system so
without it there are many unanswered questions
about the medication pathway such as: how much
is being prescribed, is it being used and how much
is being wasted?
In New Zealand, the importance of information is
being emphasised by organisations established to
extract more value from the vast resources of data
we now generate. There is a growing
understanding about the power of using
information to drive efficiencies in many different
areas of society, healthcare included.
The New Zealand Data Futures Forum has put
forward its approach to drive social and economic
value from data based on four foundational
principles: value, trust, inclusion and control.
Now as the Data Futures Partnership, a
government appointed body, it is promoting
high-trust and high value data use for all New
Zealanders as a collective effort across public,
private and NGO sectors
(www.nzdatafutures.org.nz).
In economic terms the importance of information
can be measured in the potential cost saving from
early identification of at risk patients.
there is growing understanding about the power of using information to drive efficiencies in many different areas of society
For instance, in New Zealand it’s been estimated
that treating one person with diabetes over their
lifetime can cost up to $1m, with some saying this
is a conservative figure. The number of New
Zealanders living with diabetes has doubled from
125,000 to 250,000 in the past ten years and it is
estimated a further 1.1 million people have
pre-diabetes and a high risk of developing the
disease (Diabetes New Zealand, 2015).
With these staggering numbers any early detection
followed by measures to reduce the risk has the
potential to save the country hundreds of millions
of dollars.
To achieve this we need to use information more
effectively – we can’t afford not to do this. While
there is progress in our attitude towards data and
its value, in healthcare we are not yet using the
data we have today to improve our health for the
future.
9
WHAT MORE ISNEEDED IN THE FUTURE?
Better use of data
The most important aspect of progress needed in
the immediate future is the more effective use of
non-identifiable information. This alone will help
reduce medication waste in the system, along with
reducing costs of other aspects of healthcare.
In New Zealand, we already have momentum for
this one aspect through systems such as the New
Zealand ePrescription Service (NZePS) and the
development of a single national electronic health
record, announced by Health Minister Jonathan
Coleman (NZDoctor.co.nz, 10.10.15).
we can use non-identifiable information to accurately analyse medication use
If we can use non-identifiable information to
accurately analyse medication use and non-use, by
whom, when and where, we can make great strides
towards reducing waste. The evidence from other
countries using an electronic health record, tells us
the better use of information drives healthcare to
be more effective. Studies have demonstrated the
efficacy of health information technology for
improving quality and efficiency (Chaudhry et al,
2005).
Benefits include enhanced delivery of care,
especially in the area of preventative health,
enhanced monitoring and surveillance activities,
reduction of medication errors and decreased
rates of utilisation of potentially redundant or
inappropriate care (Chaudhry et al, 2005).
the upstream management of healthcare is essential to produce downstream benefit
While consumer non-adherence is a significant
factor, a strategy to combat pharmaceutical waste
should include preventative measures that
encompass all facets of drug accumulation and
waste (Ruhoy & Daughton, 2005).
Charting the course to less waste in rest homes
Electronic medication management for rest homes
allows prescribers to see actual medicine
consumption records of a patient as well as
recording and displaying information from a
facility, for the prescriber, in real time. This helps
determine not only if a medicine is appropriate but
also whether the patient does (or wants to) take the
medication.
A system like Medi-Map, developed in New
Zealand, has this functionality and results in better
decisions on not only what medicine to prescribe
but quantities based on actual consumption and
feedback about non-compliance and reasons why.
It also helps prescribers be more flexible in making
decisions about delayed starts or ceasing
medications when necessary, which also helps
reduce waste.
Greg Garratt, CEO, MediMap NZ
10
The upstream management of healthcare is
essential to produce downstream benefit. This
means management moving up the medication
supply chain, supported by information and it’s
analysis .
More information technology
Widespread adoption of information technology is
now regarded as a pathway to improving
healthcare (Tang & Lansky, 2005). While dated,
this comment is more true today than it was over a
decade ago.
There are national systems that can play a role,
such as EHR and ePrescribing, as well as small scale
patient centric systems such as health apps, texting
reminder systems and telehealth support.
There are many envisaged benefits from EHR
systems including increased efficiency in
healthcare organisation and delivery through:
improved data sharing, data quality, security and
availability, reduced errors, patient empowerment
and time savings for staff (Morrison et al, 2010).
Countries around the world are implementing EHR
systems to realise these benefits, in some cases the
adoption of health information technology has
become one of the few widely supported,
bipartisan initiatives in the fragmented, often
contentious health care sector (Chaudhry et al,
2005).
Due to the scale of such implementations there’s
an evolutionary approach rather than a revolution.
Healthcare is also very conservative and complex
in nature and comes with significant political
involvement so any solutions will have associated
hurdles to overcome.
New Zealand’s approach to adopting health IT is
evolving; around 16 per cent of GP practices use
the New Zealand ePrescription Service (NZePS)
after being launched in 2014, while almost all
community pharmacies that are on the Connected
Health Network are now connected to NZePS.
Regarding patient portals, 100,000 Kiwis have
signed up to the service after two years of
operation. Changing behaviour of healthcare
professionals, as well as patients, is needed if we
are to make strides towards using information and
technology more effectively.
Changing the behaviour of patients and the need for more engagement
In their paper “The Missing Link: Bridging the
Patient-Provider Health Information Gap” (2005)
Tang & Lanzky talked about patients being the
co-pilots of their care.
Eleven years later, in New Zealand there is much
discussion about personal control over healthcare
or people being the CEO of their own care. The
New Zealand Health Strategy, announced in
October 2015, includes "people powered" as one
of its five strategic themes.
This approach was supported internationally in
2010 by the signing of the Salzburg Statement on
Shared Decision Making, calling on patients and
clinicians to work together to be co-producers of
health.
the New Zealand health strategy includes 'people powered' as one of its five strategic themes
All this points to people having more involvement
in their healthcare and working alongside their
doctor. Tang and Lanzky say at a minimum patients
need access to information from their providers:
diagnoses, medications, allergies, lab test results,
visit summaries and other findings over time. A
continuous healing relationship is a two way
interaction (whether electronic or face-to-face)
between patients and their providers (Tang &
Lanzky, 2005).
engagement with patients through IT systems breeds better, stronger, closer relationships between healthcare provider and patient
Engagement with patients, through the use of IT
systems is highly important as it breeds a better,
stronger, closer relationship between healthcare
provider and patient. The transparency delivered
by this provides patients with empowerment and
control, which helps them understand their health
better. A benefit of this is improved adherence.
Changing Behaviours: physicians and patients
The Regenstrief Institute paper: “The Promise of
Information and Communication Technology in
Healthcare: Extracting Value from the Chaos” (Feb
2016) emphasises the importance of physicians and
patients changing behaviours to extract the most
from health IT. Authors William Tierney, M.D. and
Burke Mamlin M.D., say:
“We can’t assume someone else will make the right
decisions with health IT. It’s going to take
everyone’s involvement, including providers and
patients, to raise expectations and drive the needed
changes. This isn’t a passive process.
“Getting to a desirable future where health IT is
appropriately employed to benefit human health
isn’t a technical problem – the technologies already
exist. It’s a health policy and sociology problem,”
said Dr Tierney.
“Too often, health IT designed to emulate paper
processes becomes a distraction to care. The
promise of health IT is for it to become a valuable
part of the healthcare team, a participant in the
conversation. And we as physicians must
understand its potential and become active
participants in its development or the potential,”
said Dr Mamlin.
“As healthcare IT becomes more pervasive, and as
technology becomes part of everyday life for a
growing percentage of physicians and patients,
both stakeholders are becoming more comfortable
with the greater amounts of data available and
more demanding of its use in support of health.”
11
The upstream management of healthcare is
essential to produce downstream benefit. This
means management moving up the medication
supply chain, supported by information and it’s
analysis .
More information technology
Widespread adoption of information technology is
now regarded as a pathway to improving
healthcare (Tang & Lansky, 2005). While dated,
this comment is more true today than it was over a
decade ago.
There are national systems that can play a role,
such as EHR and ePrescribing, as well as small scale
patient centric systems such as health apps, texting
reminder systems and telehealth support.
There are many envisaged benefits from EHR
systems including increased efficiency in
healthcare organisation and delivery through:
improved data sharing, data quality, security and
availability, reduced errors, patient empowerment
and time savings for staff (Morrison et al, 2010).
Countries around the world are implementing EHR
systems to realise these benefits, in some cases the
adoption of health information technology has
become one of the few widely supported,
bipartisan initiatives in the fragmented, often
contentious health care sector (Chaudhry et al,
2005).
Due to the scale of such implementations there’s
an evolutionary approach rather than a revolution.
Healthcare is also very conservative and complex
in nature and comes with significant political
involvement so any solutions will have associated
hurdles to overcome.
New Zealand’s approach to adopting health IT is
evolving; around 16 per cent of GP practices use
the New Zealand ePrescription Service (NZePS)
after being launched in 2014, while almost all
community pharmacies that are on the Connected
Health Network are now connected to NZePS.
Regarding patient portals, 100,000 Kiwis have
signed up to the service after two years of
operation. Changing behaviour of healthcare
professionals, as well as patients, is needed if we
are to make strides towards using information and
technology more effectively.
Changing the behaviour of patients and the need for more engagement
In their paper “The Missing Link: Bridging the
Patient-Provider Health Information Gap” (2005)
Tang & Lanzky talked about patients being the
co-pilots of their care.
Eleven years later, in New Zealand there is much
discussion about personal control over healthcare
or people being the CEO of their own care. The
New Zealand Health Strategy, announced in
October 2015, includes "people powered" as one
of its five strategic themes.
This approach was supported internationally in
2010 by the signing of the Salzburg Statement on
Shared Decision Making, calling on patients and
clinicians to work together to be co-producers of
health.
the New Zealand health strategy includes 'people powered' as one of its five strategic themes
All this points to people having more involvement
in their healthcare and working alongside their
doctor. Tang and Lanzky say at a minimum patients
need access to information from their providers:
diagnoses, medications, allergies, lab test results,
visit summaries and other findings over time. A
continuous healing relationship is a two way
interaction (whether electronic or face-to-face)
between patients and their providers (Tang &
Lanzky, 2005).
engagement with patients through IT systems breeds better, stronger, closer relationships between healthcare provider and patient
Engagement with patients, through the use of IT
systems is highly important as it breeds a better,
stronger, closer relationship between healthcare
provider and patient. The transparency delivered
by this provides patients with empowerment and
control, which helps them understand their health
better. A benefit of this is improved adherence.
Changing Behaviours: physicians and patients
The Regenstrief Institute paper: “The Promise of
Information and Communication Technology in
Healthcare: Extracting Value from the Chaos” (Feb
2016) emphasises the importance of physicians and
patients changing behaviours to extract the most
from health IT. Authors William Tierney, M.D. and
Burke Mamlin M.D., say:
“We can’t assume someone else will make the right
decisions with health IT. It’s going to take
everyone’s involvement, including providers and
patients, to raise expectations and drive the needed
changes. This isn’t a passive process.
“Getting to a desirable future where health IT is
appropriately employed to benefit human health
isn’t a technical problem – the technologies already
exist. It’s a health policy and sociology problem,”
said Dr Tierney.
“Too often, health IT designed to emulate paper
processes becomes a distraction to care. The
promise of health IT is for it to become a valuable
part of the healthcare team, a participant in the
conversation. And we as physicians must
understand its potential and become active
participants in its development or the potential,”
said Dr Mamlin.
“As healthcare IT becomes more pervasive, and as
technology becomes part of everyday life for a
growing percentage of physicians and patients,
both stakeholders are becoming more comfortable
with the greater amounts of data available and
more demanding of its use in support of health.”
12
The changing behaviours of patients will also need
to be matched with increased support from
clinicians and doctors for a more patient centric
approach to healthcare.
In terms of medication use, one way to achieve
more effective adherence will be for healthcare
professionals to put more emphasis on the
importance of prescription filling, starting and
finishing. While appointment times are always
pressured, a consistent, simple and strong message
to patients about adherence would be beneficial.
There is obvious desire by people to be more
involved and engaged in their health, with the
growth in development of health apps and
technology driven support for all generations.
Changing perception about privacy
New Zealand’s Privacy Act has been a mainstay of
society since it received its Royal assent in 1993 as
a control over agencies collecting, using, disclosing,
storing and giving access to “personal”
information. New Zealanders benefit from the
protection it provides for personal identifiable
information, whether digital or offline.
Its key focus is personal information.
Diane Robertson, former head of Auckland City
Mission and now Chairwoman of the Data Futures
Partnership, commented at her appointment in
October 2015 about the public’s perception of
privacy: “the issue we have to look at here is the
difference between ‘personal’ information and
information that is depersonalised with all
‘identifiers’ taken off and used as ‘data’ to give us
some better information” (stuff.co.nz, Oct 2015).
Her comments came after a Cabinet paper in
August 2015 describing public trust in data sharing
as tenuous.
The work of the Data Futures Partnership, and
others in the information industry, should be
applauded as it is starting to grow understanding
about how information can be used to improve
society, healthcare being a vital part.
Clearly there is much work to do for everyone in
the information sector to build understanding
about different types of information and the need
for privacy to be applied appropriately so that
benefits from non-identifiable information can be
realised.
More investment in medications adherence
With adherence being such a prominent area of
concern, more research and investment on
improvements is essential by both the public and
commercial sectors.
There is a clear business case for adherence
programmes due to wide ranging impacts of
non-adherence.
The pharmaceutical industry does invest in
adherence programmes and has increased its
spend globally. Medicines companies in New
Zealand often undertake adherence programmes.
there is a clear business case for more investment in the pharmaceutical industry to invest in adherence
An example of partnership is PHARMAC working
with Atlantis Healthcare on its own multi-channel
adherence programme for people living with Type
2 Diabetes, with promising preliminary results
including: improved perceptions of the disease,
improved adherence and a decrease in healthcare
utilisation.
For governments any improvement to adherence
will reduce hospitalisations and free up beds for
those who really need them.
With both commercial and government sectors set
to gain from improved adherence, a potential
question is whether there’s opportunity for more
emphasis on a Private Public Partnership (PPP)
approach to adherence?
is there opportunity for more emphasis on a Private Public Partnership (PPP) approach to adherence?
No matter what the investment channel to
enhance adherence – be it electronic or
pharmacist-led counselling – actively encouraging
medicine adherence for patients should be one of
the priorities in the healthcare sector in New
Zealand, and the medicines industry wants to be
part of this through well-resourced public-private
partnerships.
The benefits of adherence are substantial and the
cost savings achieved are in some cases significant,
despite what is perceived as more investment
being made initially.
In one overseas study the benefit:cost ratios
ranged from 2:1 to 13:1 for patients with chronic
vascular disease from adhering to their prescribed
medicines. These benefits resulted from reduced
hospitalisation and emergency department use.
In addition to this, people who adhere to
medications become more active and productive
and have better quality adjusted life years (QALYs).
Such data and results support the case for policy to
promote the better use of medicines to improve
health outcomes and reduce spending overall.
Changing the delivery system
We have become lazy with our medication delivery
system whereby bulk prescriptions are provided
that are convenient for the dispenser and the
patient. This ready-as-needed approach
maximises the chances the medications will not be
needed, eventually leading to expiration and the
necessity of their disposal (Ruhoy & Daughton,
2008).
we have become lazy with our medication delivery system
Within the medication supply chain there are
major opportunities to prevent wastage and
accumulation of medications including: unit dosing,
trial scripts, low-quantity packaging of OTC
medications, increased monitoring of patients,
implementing the practice of concordance, free
samples and donations, reducing incentives for
excessive purchasing (Ruhoy and Daughton, 2008).
This will mean altering the consumption and
behaviour patterns of consumers. Unit dispensing,
as opposed to bulk dispensing, has the potential to
deliver the correct dosage of drug with the correct
timing (Ruhoy & Daughton, 2008).
This raises a question about the economic benefit
of delivering medications in smaller batches but
more regularly, which also creates more
opportunity for patient engagement and the
monitoring of non-adherence.
There are challenges with this approach, one being
it assumes patients will have the capacity to collect
their medication more frequently, and if they don't
the result will be greater non-adherence. Also, it
does not address the psychological drivers and
practical barriers of non-adherence.
Another is more dispensing will increase costs,
which goes against the current climate of
reduction.
However, both these ignore the potential for more
frequency leading to less waste, more adherence
and significant savings in secondary care. More
regular dispensing could be supported by delivery
rather than pick-up or even home visits. While this
seems extravagant and expensive the potential
savings in secondary care could warrant such an
approach.
An example of a business where this already
happens is supply chain and logistics where
database and inventory technology is very specific.
Manufacturing companies are able to accurately
estimate demand and potential orders from their
various customer retailers and wholesalers. This
allows them to produce exactly what is needed,
when it is needed (Ruhoy & Daughton, 2008).
within the medication supply chain there are major opportunities to prevent wastage
If only looking at the prescribing and dispensing
process, more frequency wouldn’t make sense.
But if the whole of healthcare is considered then
the case could become stronger.
More research into the potential economic upside
from a different delivery approach is needed.
13
The changing behaviours of patients will also need
to be matched with increased support from
clinicians and doctors for a more patient centric
approach to healthcare.
In terms of medication use, one way to achieve
more effective adherence will be for healthcare
professionals to put more emphasis on the
importance of prescription filling, starting and
finishing. While appointment times are always
pressured, a consistent, simple and strong message
to patients about adherence would be beneficial.
There is obvious desire by people to be more
involved and engaged in their health, with the
growth in development of health apps and
technology driven support for all generations.
Changing perception about privacy
New Zealand’s Privacy Act has been a mainstay of
society since it received its Royal assent in 1993 as
a control over agencies collecting, using, disclosing,
storing and giving access to “personal”
information. New Zealanders benefit from the
protection it provides for personal identifiable
information, whether digital or offline.
Its key focus is personal information.
Diane Robertson, former head of Auckland City
Mission and now Chairwoman of the Data Futures
Partnership, commented at her appointment in
October 2015 about the public’s perception of
privacy: “the issue we have to look at here is the
difference between ‘personal’ information and
information that is depersonalised with all
‘identifiers’ taken off and used as ‘data’ to give us
some better information” (stuff.co.nz, Oct 2015).
Her comments came after a Cabinet paper in
August 2015 describing public trust in data sharing
as tenuous.
The work of the Data Futures Partnership, and
others in the information industry, should be
applauded as it is starting to grow understanding
about how information can be used to improve
society, healthcare being a vital part.
Clearly there is much work to do for everyone in
the information sector to build understanding
about different types of information and the need
for privacy to be applied appropriately so that
benefits from non-identifiable information can be
realised.
More investment in medications adherence
With adherence being such a prominent area of
concern, more research and investment on
improvements is essential by both the public and
commercial sectors.
There is a clear business case for adherence
programmes due to wide ranging impacts of
non-adherence.
The pharmaceutical industry does invest in
adherence programmes and has increased its
spend globally. Medicines companies in New
Zealand often undertake adherence programmes.
there is a clear business case for more investment in the pharmaceutical industry to invest in adherence
An example of partnership is PHARMAC working
with Atlantis Healthcare on its own multi-channel
adherence programme for people living with Type
2 Diabetes, with promising preliminary results
including: improved perceptions of the disease,
improved adherence and a decrease in healthcare
utilisation.
For governments any improvement to adherence
will reduce hospitalisations and free up beds for
those who really need them.
With both commercial and government sectors set
to gain from improved adherence, a potential
question is whether there’s opportunity for more
emphasis on a Private Public Partnership (PPP)
approach to adherence?
is there opportunity for more emphasis on a Private Public Partnership (PPP) approach to adherence?
No matter what the investment channel to
enhance adherence – be it electronic or
pharmacist-led counselling – actively encouraging
medicine adherence for patients should be one of
the priorities in the healthcare sector in New
Zealand, and the medicines industry wants to be
part of this through well-resourced public-private
partnerships.
The benefits of adherence are substantial and the
cost savings achieved are in some cases significant,
despite what is perceived as more investment
being made initially.
In one overseas study the benefit:cost ratios
ranged from 2:1 to 13:1 for patients with chronic
vascular disease from adhering to their prescribed
medicines. These benefits resulted from reduced
hospitalisation and emergency department use.
In addition to this, people who adhere to
medications become more active and productive
and have better quality adjusted life years (QALYs).
Such data and results support the case for policy to
promote the better use of medicines to improve
health outcomes and reduce spending overall.
Changing the delivery system
We have become lazy with our medication delivery
system whereby bulk prescriptions are provided
that are convenient for the dispenser and the
patient. This ready-as-needed approach
maximises the chances the medications will not be
needed, eventually leading to expiration and the
necessity of their disposal (Ruhoy & Daughton,
2008).
we have become lazy with our medication delivery system
Within the medication supply chain there are
major opportunities to prevent wastage and
accumulation of medications including: unit dosing,
trial scripts, low-quantity packaging of OTC
medications, increased monitoring of patients,
implementing the practice of concordance, free
samples and donations, reducing incentives for
excessive purchasing (Ruhoy and Daughton, 2008).
This will mean altering the consumption and
behaviour patterns of consumers. Unit dispensing,
as opposed to bulk dispensing, has the potential to
deliver the correct dosage of drug with the correct
timing (Ruhoy & Daughton, 2008).
This raises a question about the economic benefit
of delivering medications in smaller batches but
more regularly, which also creates more
opportunity for patient engagement and the
monitoring of non-adherence.
There are challenges with this approach, one being
it assumes patients will have the capacity to collect
their medication more frequently, and if they don't
the result will be greater non-adherence. Also, it
does not address the psychological drivers and
practical barriers of non-adherence.
Another is more dispensing will increase costs,
which goes against the current climate of
reduction.
However, both these ignore the potential for more
frequency leading to less waste, more adherence
and significant savings in secondary care. More
regular dispensing could be supported by delivery
rather than pick-up or even home visits. While this
seems extravagant and expensive the potential
savings in secondary care could warrant such an
approach.
An example of a business where this already
happens is supply chain and logistics where
database and inventory technology is very specific.
Manufacturing companies are able to accurately
estimate demand and potential orders from their
various customer retailers and wholesalers. This
allows them to produce exactly what is needed,
when it is needed (Ruhoy & Daughton, 2008).
within the medication supply chain there are major opportunities to prevent wastage
If only looking at the prescribing and dispensing
process, more frequency wouldn’t make sense.
But if the whole of healthcare is considered then
the case could become stronger.
More research into the potential economic upside
from a different delivery approach is needed.
14
The changing behaviours of patients will also need
to be matched with increased support from
clinicians and doctors for a more patient centric
approach to healthcare.
In terms of medication use, one way to achieve
more effective adherence will be for healthcare
professionals to put more emphasis on the
importance of prescription filling, starting and
finishing. While appointment times are always
pressured, a consistent, simple and strong message
to patients about adherence would be beneficial.
There is obvious desire by people to be more
involved and engaged in their health, with the
growth in development of health apps and
technology driven support for all generations.
Changing perception about privacy
New Zealand’s Privacy Act has been a mainstay of
society since it received its Royal assent in 1993 as
a control over agencies collecting, using, disclosing,
storing and giving access to “personal”
information. New Zealanders benefit from the
protection it provides for personal identifiable
information, whether digital or offline.
Its key focus is personal information.
Diane Robertson, former head of Auckland City
Mission and now Chairwoman of the Data Futures
Partnership, commented at her appointment in
October 2015 about the public’s perception of
privacy: “the issue we have to look at here is the
difference between ‘personal’ information and
information that is depersonalised with all
‘identifiers’ taken off and used as ‘data’ to give us
some better information” (stuff.co.nz, Oct 2015).
Her comments came after a Cabinet paper in
August 2015 describing public trust in data sharing
as tenuous.
The work of the Data Futures Partnership, and
others in the information industry, should be
applauded as it is starting to grow understanding
about how information can be used to improve
society, healthcare being a vital part.
Clearly there is much work to do for everyone in
the information sector to build understanding
about different types of information and the need
for privacy to be applied appropriately so that
benefits from non-identifiable information can be
realised.
More investment in medications adherence
With adherence being such a prominent area of
concern, more research and investment on
improvements is essential by both the public and
commercial sectors.
There is a clear business case for adherence
programmes due to wide ranging impacts of
non-adherence.
The pharmaceutical industry does invest in
adherence programmes and has increased its
spend globally. Medicines companies in New
Zealand often undertake adherence programmes.
there is a clear business case for more investment in the pharmaceutical industry to invest in adherence
An example of partnership is PHARMAC working
with Atlantis Healthcare on its own multi-channel
adherence programme for people living with Type
2 Diabetes, with promising preliminary results
including: improved perceptions of the disease,
improved adherence and a decrease in healthcare
utilisation.
For governments any improvement to adherence
will reduce hospitalisations and free up beds for
those who really need them.
With both commercial and government sectors set
to gain from improved adherence, a potential
question is whether there’s opportunity for more
emphasis on a Private Public Partnership (PPP)
approach to adherence?
is there opportunity for more emphasis on a Private Public Partnership (PPP) approach to adherence?
No matter what the investment channel to
enhance adherence – be it electronic or
pharmacist-led counselling – actively encouraging
medicine adherence for patients should be one of
the priorities in the healthcare sector in New
Zealand, and the medicines industry wants to be
part of this through well-resourced public-private
partnerships.
The benefits of adherence are substantial and the
cost savings achieved are in some cases significant,
despite what is perceived as more investment
being made initially.
In one overseas study the benefit:cost ratios
ranged from 2:1 to 13:1 for patients with chronic
vascular disease from adhering to their prescribed
medicines. These benefits resulted from reduced
hospitalisation and emergency department use.
In addition to this, people who adhere to
medications become more active and productive
and have better quality adjusted life years (QALYs).
Such data and results support the case for policy to
promote the better use of medicines to improve
health outcomes and reduce spending overall.
Changing the delivery system
We have become lazy with our medication delivery
system whereby bulk prescriptions are provided
that are convenient for the dispenser and the
patient. This ready-as-needed approach
maximises the chances the medications will not be
needed, eventually leading to expiration and the
necessity of their disposal (Ruhoy & Daughton,
2008).
we have become lazy with our medication delivery system
Within the medication supply chain there are
major opportunities to prevent wastage and
accumulation of medications including: unit dosing,
trial scripts, low-quantity packaging of OTC
medications, increased monitoring of patients,
implementing the practice of concordance, free
samples and donations, reducing incentives for
excessive purchasing (Ruhoy and Daughton, 2008).
This will mean altering the consumption and
behaviour patterns of consumers. Unit dispensing,
as opposed to bulk dispensing, has the potential to
deliver the correct dosage of drug with the correct
timing (Ruhoy & Daughton, 2008).
This raises a question about the economic benefit
of delivering medications in smaller batches but
more regularly, which also creates more
opportunity for patient engagement and the
monitoring of non-adherence.
There are challenges with this approach, one being
it assumes patients will have the capacity to collect
their medication more frequently, and if they don't
the result will be greater non-adherence. Also, it
does not address the psychological drivers and
practical barriers of non-adherence.
Another is more dispensing will increase costs,
which goes against the current climate of
reduction.
However, both these ignore the potential for more
frequency leading to less waste, more adherence
and significant savings in secondary care. More
regular dispensing could be supported by delivery
rather than pick-up or even home visits. While this
seems extravagant and expensive the potential
savings in secondary care could warrant such an
approach.
An example of a business where this already
happens is supply chain and logistics where
database and inventory technology is very specific.
Manufacturing companies are able to accurately
estimate demand and potential orders from their
various customer retailers and wholesalers. This
allows them to produce exactly what is needed,
when it is needed (Ruhoy & Daughton, 2008).
within the medication supply chain there are major opportunities to prevent wastage
If only looking at the prescribing and dispensing
process, more frequency wouldn’t make sense.
But if the whole of healthcare is considered then
the case could become stronger.
More research into the potential economic upside
from a different delivery approach is needed.
15
Reducing
LESS WASTE MEANS LESS NEED ACROSS HEALTHCAREReducing medications waste is just one of the
many benefits resulting from more effectively
using information and technology, in addition to
many others such as savings in time and resources.
As this paper has shown, it won’t be possible to rid
all waste but we can do a much better job at
reducing it. The biggest tool to use in this quest is
information, followed closely by changing the way
medications are managed and people’s attitudes
towards them.
Like most western healthcare systems ours in New
Zealand is only at the start of transforming into a
truly information driven service, supported by
technology. As this happens, the traditional view
of healthcare is changing as people become more
involved and care becomes more patient centric.
This evolution will give everyone a role in
healthcare - from clinicians, to patients, healthcare
managers and health IT specialists, we are all
responsible and we can all play a part.
To be successful we must be focused, as
proceeding with this transformation is imperative
to the very survival of an effective and affordable
healthcare system. There are too many significant
issues facing us to do anything else.
Along the way there will be many hurdles including
those that are political, privacy related and
financial. But we need to place all of these in the
context of New Zealand, and everyone who lives
here, needing affordable, accurate and efficient
healthcare.
To reduce medication waste and the cost of
avoidable secondary care, there is a far greater
need for more economic analysis and studies on
adherence and its funding, alternative delivery
systems and how technology can support
healthcare. There is urgency for this, considering
the rapidly increasing cost of caring for an ageing
population and growing numbers of people with
diabetes.
There is also need for greater education and
understanding about how clinicians, patients and
healthcare providers can all work together to
deliver a better healthcare service for all. An
important aspect of this is behavioural change
towards shared care, attitudes to privacy and
adherence.
New Zealand is a small country and we do have an
opportunity, together, to create a healthcare
system that is the envy of the world, where
efficiency and effectiveness is paramount, and all
aspects of waste are minimised.
If we are able to achieve this, we may even be able
to demonstrate the spirit of the saying, “waste not,
want not.”
16
Pound, P., Britten, N., Morgan, N., Yardley, L., Pope, C.,
Daker-White, G. & Campbell R. (2005). Resisting
medicines: a synthesis of qualitative studies of
medicine taking. Soc Sci Med, 2005; 61 (1): 135-55.
Pullar-Strecker, T. (2015). Dame Diane Robertson starts
new mission chairing data venture. Accessed at
www.stuff.co.nz on 26th April 2016.
Roebuck, C.N., Liberman, J.N., Gemmill-Toyama, M. &
Brennan, T.A. (2011). Medication adherence leads to
lower health care use and costs despite increased drug
spending. Health Affairs, 30, no. 1 (2011): 91-99.
Ruhoy, I.S., Daughton, C.G. (2008). Beyond the medicine
cabinet: An analysis of where and why medications
accumulate. Environment International, 34, 1157-1169.
Salzburg Global Seminar (2010). The Greatest
Untapped Resource in Healthcare? Informing and
Involving Patients in Decisions about their Medical
Care. 12-17 December 2010, (Session 477), accessed at:
http://www.salzburgglobal.org/go/477
Tang, P.C. & Langsky, D. (2005). The Missing Link:
Bridging the Patient-Provider Health Information Gap.
Health Affairs, 24 (5), p1290-1295.
Thomas, G. (2015). Medicine disposal ‘a national
disaster’. Accessed on 7th March 2016 from
www.radionz.co.nz.
Tong, A., Peake, B., & Braund, R. (2011). Disposal
practices for unused medications in New Zealand
community pharmacies. Journal of Primary Healthcare,
3 (3), 197-203
Tong, A., Peake, B., & Braund, R. (2011). Disposal
practices for unused medications around the world.
Environment International, 37, 292-298
Topham-Kindley, L. (2015). Grand plan to develop a
single national electronic health record for Kiwis. NZ
Doctor, accessed at www.nzdoctor.co.nz on 29th March
2016.
Acknowledgements:
We would like to thank the following people and
organisations who have assisted in the development of
this White Paper:
• Greg Garratt, CEO and Founding Partner,
MediMap New Zealand
• Graeme Jarvis, General Manager, and Katie
Sherriff, Communications Advisor, Medicines
New Zealand
• Anna Stove, General Manager, GlaxoSmithKline
NZ Ltd
• Olivia Anstis, Director of Clinical Strategy,
Atlantis Healthcare
• Lisa Toi, Strategic Consultant, Healthcare
BIBLIOGRAPHY
Atlantis Healthcare (2014). The science behind
treatment support. White Paper.
www.healthshared.com
Berwick, D.M., Nolan, T.W., & Whittington, J. (2008). The
triple aim: Care, health, and cost. Health Affairs, 27 (3),
p759-769.
Biotechnology Learning Hub. Accessed May 10th 2016
from http://biotechlearn.org.nz
CapGemini Consulting (2012). Estimated annual
pharmaceutical revenue loss due to medication
non-adherence.
Chaudhry, B., Wang, J., Wu, S., Maglione, M., Mogica, W.,
Roth, E., Morton, S. & Shekelle, P. (2006). Systematic
Review: Impact of Health Information Technology on
Quality, Efficiency, and Costs of Medical Care. Ann
Intern Med, 144 (10), p742-752.
Cutler, D. & Everett, W. (2010). Thinking Outside the
Pillbox - Medication Adherence as a Priority for Health
Care Reform. The New England Journal of Medicine, 362
(17), p1553-1555.
Diabetes New Zealand – Diabetes Action Month (2015).
New Zealanders implored to own up and step up to
country’s fastest growing health crisis. Press release,
November 3rd 2015.
Dictionary.com "waste not, want not," in The American
Heritage® Dictionary of Idioms by Christine Ammer.
Source location: Houghton Mifflin Company.
http://www.dictionary.com/browse/waste-not--want-no
t. Available: http://www.dictionary.com/. Accessed: April
25, 2016.
Drucker, P.F., (1954). The Practice of Management.
Ellickson, P., Stern, S. & Trajtenberg, M. (1999). Patient
welfare and patient compliance: an empirical
framework for measuring the benefits from
pharmaceutical innovation. NBER working paper 6890.
Groves, P., Kayyali, B., Knott, D., Kuiken, S Van. (2013).
The 'big data' revolution in healthcare. McKinsey
Quarterly.
Johnson, L. (2013). WISE UP – Smarter Med Use Could
Cut Drug Costs; Study Finds a Prescription for Saving
$213 Billion a Year. St Louis Post-Dispatch (MO).
Kadambi, A., Leipold, R. J., Kansal, A. R., Sorensen, S., &
Getsios, D. (2012). Inclusion of Compliance and
Persistence in Economic Models. Applied Health
Economics and Health Policy, Vol. 10 (6).
Knowles, C., (2016). Information technology is radically
reshaping the healthcare sector. Accessed 29th March
2016, from www.itbrief.co.nz.
Morgan, T. (2005). The Economic Impact of Wasted
Prescription Medication in an Outpatient Population
of Older Adults. J Pam Practice, 50 (9), p779-781.
Morrison, Z. & Robertson, Ann. (2010). Understanding
contrasting approaches to nationwide
implementations of electronic health record systems:
England, the USA and Australia. Journal of Healthcare
Engineering, 2 (1), 25-41.
New Zealand Data Futures Forum. Accessed March 22
2016, from https://www.nzdatafutures.org.nz
Pharmac (2016). Pharmac, diabetes and adherence –
presentation for Atlantis Bright Brekkie, by Janet Mackay,
25 February 2016.
17
Pound, P., Britten, N., Morgan, N., Yardley, L., Pope, C.,
Daker-White, G. & Campbell R. (2005). Resisting
medicines: a synthesis of qualitative studies of
medicine taking. Soc Sci Med, 2005; 61 (1): 135-55.
Pullar-Strecker, T. (2015). Dame Diane Robertson starts
new mission chairing data venture. Accessed at
www.stuff.co.nz on 26th April 2016.
Roebuck, C.N., Liberman, J.N., Gemmill-Toyama, M. &
Brennan, T.A. (2011). Medication adherence leads to
lower health care use and costs despite increased drug
spending. Health Affairs, 30, no. 1 (2011): 91-99.
Ruhoy, I.S., Daughton, C.G. (2008). Beyond the medicine
cabinet: An analysis of where and why medications
accumulate. Environment International, 34, 1157-1169.
Salzburg Global Seminar (2010). The Greatest
Untapped Resource in Healthcare? Informing and
Involving Patients in Decisions about their Medical
Care. 12-17 December 2010, (Session 477), accessed at:
http://www.salzburgglobal.org/go/477
Tang, P.C. & Langsky, D. (2005). The Missing Link:
Bridging the Patient-Provider Health Information Gap.
Health Affairs, 24 (5), p1290-1295.
Thomas, G. (2015). Medicine disposal ‘a national
disaster’. Accessed on 7th March 2016 from
www.radionz.co.nz.
Tong, A., Peake, B., & Braund, R. (2011). Disposal
practices for unused medications in New Zealand
community pharmacies. Journal of Primary Healthcare,
3 (3), 197-203
Tong, A., Peake, B., & Braund, R. (2011). Disposal
practices for unused medications around the world.
Environment International, 37, 292-298
Topham-Kindley, L. (2015). Grand plan to develop a
single national electronic health record for Kiwis. NZ
Doctor, accessed at www.nzdoctor.co.nz on 29th March
2016.
Acknowledgements:
We would like to thank the following people and
organisations who have assisted in the development of
this White Paper:
• Greg Garratt, CEO and Founding Partner,
MediMap New Zealand
• Graeme Jarvis, General Manager, and Katie
Sherriff, Communications Advisor, Medicines
New Zealand
• Anna Stove, General Manager, GlaxoSmithKline
NZ Ltd
• Olivia Anstis, Director of Clinical Strategy,
Atlantis Healthcare
• Lisa Toi, Strategic Consultant, Healthcare
BIBLIOGRAPHY
Atlantis Healthcare (2014). The science behind
treatment support. White Paper.
www.healthshared.com
Berwick, D.M., Nolan, T.W., & Whittington, J. (2008). The
triple aim: Care, health, and cost. Health Affairs, 27 (3),
p759-769.
Biotechnology Learning Hub. Accessed May 10th 2016
from http://biotechlearn.org.nz
CapGemini Consulting (2012). Estimated annual
pharmaceutical revenue loss due to medication
non-adherence.
Chaudhry, B., Wang, J., Wu, S., Maglione, M., Mogica, W.,
Roth, E., Morton, S. & Shekelle, P. (2006). Systematic
Review: Impact of Health Information Technology on
Quality, Efficiency, and Costs of Medical Care. Ann
Intern Med, 144 (10), p742-752.
Cutler, D. & Everett, W. (2010). Thinking Outside the
Pillbox - Medication Adherence as a Priority for Health
Care Reform. The New England Journal of Medicine, 362
(17), p1553-1555.
Diabetes New Zealand – Diabetes Action Month (2015).
New Zealanders implored to own up and step up to
country’s fastest growing health crisis. Press release,
November 3rd 2015.
Dictionary.com "waste not, want not," in The American
Heritage® Dictionary of Idioms by Christine Ammer.
Source location: Houghton Mifflin Company.
http://www.dictionary.com/browse/waste-not--want-no
t. Available: http://www.dictionary.com/. Accessed: April
25, 2016.
Drucker, P.F., (1954). The Practice of Management.
Ellickson, P., Stern, S. & Trajtenberg, M. (1999). Patient
welfare and patient compliance: an empirical
framework for measuring the benefits from
pharmaceutical innovation. NBER working paper 6890.
Groves, P., Kayyali, B., Knott, D., Kuiken, S Van. (2013).
The 'big data' revolution in healthcare. McKinsey
Quarterly.
Johnson, L. (2013). WISE UP – Smarter Med Use Could
Cut Drug Costs; Study Finds a Prescription for Saving
$213 Billion a Year. St Louis Post-Dispatch (MO).
Kadambi, A., Leipold, R. J., Kansal, A. R., Sorensen, S., &
Getsios, D. (2012). Inclusion of Compliance and
Persistence in Economic Models. Applied Health
Economics and Health Policy, Vol. 10 (6).
Knowles, C., (2016). Information technology is radically
reshaping the healthcare sector. Accessed 29th March
2016, from www.itbrief.co.nz.
Morgan, T. (2005). The Economic Impact of Wasted
Prescription Medication in an Outpatient Population
of Older Adults. J Pam Practice, 50 (9), p779-781.
Morrison, Z. & Robertson, Ann. (2010). Understanding
contrasting approaches to nationwide
implementations of electronic health record systems:
England, the USA and Australia. Journal of Healthcare
Engineering, 2 (1), 25-41.
New Zealand Data Futures Forum. Accessed March 22
2016, from https://www.nzdatafutures.org.nz
Pharmac (2016). Pharmac, diabetes and adherence –
presentation for Atlantis Bright Brekkie, by Janet Mackay,
25 February 2016.
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